Facial nerve function following temporomandibular joint surgery using the preauricular approach.

Sixty-eight patients (83 temporomandibular joints) consecutively operated on who had a variety of temporomandibular joint operations using a preauricular approach were assessed for facial nerve function following surgery. Nine patients (10.84%) showed signs of facial nerve injury in which the temporal and zygomatic branches were involved. The incidence of facial nerve injury was greater in patients who had undergone previous temporomandibular joint surgery (17.64%) than in patients with previously unoperated joints (9%). Normal facial nerve function returned in 9 to 14 weeks except in one patient who showed a mild deficit of the zygomatic branch at 20 weeks. The nature and duration of the surgical procedure did not correlate with facial nerve injury. Scarring of tissues as a result of previous temporomandibular joint surgery may significantly increase the risk of facial nerve injury during subsequent temporomandibular joint surgery.     

改良耳颞切口在颞下颌关节手术中的应用

目的:评价改良耳颞切口在颞下颌关节手术中的效果。方法:回顾分析1998年7月～2002年11月间收治的72例颞下颌关节病患者,男性35例,女性38例,年龄4～72岁,平均年龄36.1岁。所有患者均采用改良耳颞切口及进路术式,于耳颞部行美容切口设计,先翻开耳前皮瓣,暴露颞浅血管分支,然后沿耳颞神经血管束前缘进入,向前下翻开颞深筋膜瓣,倒“L”形切开关节囊后暴露髁突。结果:72例患者中获得随访38例(49侧),随访期4～45个月,平均17.7个月。仅1侧右颞区皮肤麻木,3侧额纹消失,总体对手术切口满意度为97.4%(37/38),不满意1例为髁突骨折患者,术后8个月术区瘢痕仍很明显,伴有颞区皮肤麻木和额纹消失。结论:改良耳颞切口及进路是目前治疗颞下颌关节疾病的理想术式之一。     

A modified auriculotemporal nerve block for regional anesthesia of the temporomandibular joint

A technique for producing regional auriculotemporal nerve analgesia is described. Undesirable side effects have been minimized by avoiding facial nerve branches and blood vessels, and injection at the site of the nerve trunk.     

正颌外科治疗后颞下颌关节改变的X线研究

目的 了解正颌外科手术后颞下颌关节（ｔｅｍｐｏｒｏｍａｎｄｉｂｕｌａｒ ｊｏｉｎｔ,ＴＭＪ）形态的改变,探讨手术方式不同对ＴＭＪ的影响。方法 正颌手术患者５７例,术前、术后１周、１年分别拍摄定位许勒位片用于观察髁突位置及关节形态的变化。结果 ①正颌手术可导致髁突移位,但大多数关节适应后并不发生病变,术后１年髁突位置已调整到术前相似的位置。②手术方式不同髁突位置的变化也不尽相同。③８６．４％的患者关节无明显变化或发生了适应性改建;１３．６％患者关节发生了退行性改变。结论 正颌手术可对ＴＭＪ产生影响,但大部分处于关节的正常适应范围内。     

Morbidity associated with the preauricular and perimeatal approaches to the temporomandibular joint

The preauricular and perimeatal approaches to the temporomandibular joint were compared in a study involving 56 patients. It was concluded that the preauricular approach offers better access and carries less risk of serious postoperative complications.     

An approach to the management of temporomandibular joint dysfunction

Temporomandibular joint dysfunction may result from a number of causes. Perhaps the commonest is muscular hyperactivity of central origin. Consequently, the dentist has to widen his investigations to take into account the life style of the patient and to deal with the expression of mental stress as muscular tension.     

Prospective assessment of outcomes following disposable arthroscopy of the temporomandibular joint

Temporomandibular disorder (TMD) is a common cause of chronic facial pain that is often treated successfully without operation, but when no improvement is seen arthroscopy may be considered as a therapeutic and diagnostic tool. We prospectively assessed the outcome of 115 arthroscopic procedures to assess the effectiveness and reliability of a 1.2 mm disposable arthroscope (OnPoint™, Biomet Microfixation, Jacksonville, USA). All patients included had not improved after standard conservative management. Discharge from clinic was classed as a successful outcome. Measurements taken before, during, and after operation included mouth opening and lateral deviations (mm). Pain was assessed before and after operation using a 10 cm visual analogue scale. Mean improvement in pain scores was 69% and in mouth opening was 19%, and overall success was 76%. Compared with a previous study using a 1.9 mm scope there were fewer complications after arthroscopy with the small diameter scope.     

A drape for temporomandibular joint surgery

A method for draping in TMJ surgery including arthroscopy is presented using a urological drape. The advantage is that it allows movement of the mandible by the surgeon or assistant without their contamination by saliva.     

Reoperative temporomandibular joint surgery

TMJ surgeries are not always successful. Many potential pitfalls can occur during any phase of the treatment and can lead to complications, less than desirable results, and short- or long-term failures. Unsatisfactory results can occur for multiple reasons, including misdiagnosis of the original pathologic condition, incorrect selection of surgical technique, technical failures, complications, systemic disease, and unrealistic expectations. This article focuses on the reoperation of the TMJ primarily in cases of internal derangement and discusses TMJ arthrocentesis, arthroscopy, modified condylotomy, and open joint procedures.     

A case of synovial chondromatosis of the temporomandibular joint secondary to preauricular trauma

Synovial chondromatosis is a rare benign arthropathy characterized by chondrometaplasia of the synovial membrane, particularly in the temporomandibular joint (TMJ). The purpose of this article is to describe an uncommon case of synovial chondromatosis arising from the inferior joint space of the TMJ with an enlarged condyle secondary to preauricular trauma in a 44-year-old healthy male. The possible role of a traumatic event in the etiology, the usefulness of the combined performance of CT and MRI examinations for preoperative diagnosis and current treatment are discussed.     

Evaluation of the patient for temporomandibular joint surgery

Temporomandibular joint (TMJ) surgery is the preferred treatment for tumors, neoplasms, and selected injuries and infections of the TMJ. It is also an appropriate and effective treatment for subsets of temporomandibular disorders (TMDs) that are characterized by mechanical disruption of joint function. Careful and systematic clinical evaluation and imaging is required to determine if painful TMD with altered range of motion is amenable to surgery of the TMJ. This article offers a rational approach to evaluation of patients for TMJ surgery.     

Tomographic assessment of alterations of the temporomandibular joint after orthognathic surgery.

The aims of the study were: (1) to identify absolute condylar displacements and glenoid fossa changes; (2) to assess alterations in the condyle-fossa relationships following orthognathic surgery, by means of linear temporomandibular joint tomography. The sample consisted of 44 adults who received pre- and post-operative orthodontic therapy and management of their dentofacial deformities with various osteotomies (maxillary: 10; mandibular: 24; combined: 10). The material consisted of the tomograms of the right temporomandibular joints taken within 1 week pre-operatively, immediately post-surgery, and 6 months postoperatively. The X-rays were taken with the mouth closed. Tracing, superimposition, and interpretation of the tomograms were made according to a new method. The findings of the study regarding the groups which received mandibular or combined osteotomies indicated that immediately post-operatively there was a tendency for the condyle to be distracted downward and anteriorly from its original position in the fossa. However, in the 6 months follow-up the condyle showed a tendency to re-establish its initial position. Large variation in posterior space was observed among the patients of the mandibular osteotomy group who were also examined individually. In the maxillary osteotomy group no significant post-operative changes were observed on the average. Remodelling was noticed in both condylar and fossa surfaces of all groups.     

Reduction of luxation of the temporomandibular joint—An extraoral approach

The method, as described, will not reduceall luxations of the TMJ. Some patients with severe muscle spasm of long duration may require general anesthesia. However, in the vast majority of patients encountered by the author, the method described was quite successful. It was performed so easily that several patients who had recurrent problems have since been able to reduce their own luxations.     

History of temporomandibular joint surgery

This article reviews past surgical treatments for TMJ and their rationale. Because of poor outcomes with alloplastic materials in the 1980s, many experts believed TMJ surgery had failed. Those who advocated nonsurgical treatment condemned the entire discipline without recognizing the benefits of many surgical approaches. Only after 20 years of "good science" has TMJ surgery reemerged with many procedures proven highly effective.